The post “Red Flags” That Warrant a Referral for Early Intervention or Preschool Therapy Services appeared first on teachmetotalk.com.

If this is your first visit, I’d like to tell you how I recommend “first timers” navigate the site because I have TONS of info on here that may not be apparent to you with your first click!

The site is organized in chronological order with the newest entries listed first here on the home page below the green banner.

However, lots of my best information is in the older articles and most of those articles are listed by category in the BLOG section. Click BLOG for a drop down list and choose the topic that most interests you. Once you’ve clicked on that section, you’ll see articles beginning with the most recent. I started this website in 2008 so there are hundreds of posts. You may want to scroll down to the bottom of the page and hit “next page” until you’re all the way back to the beginning of so that you can read those detailed “how to” posts first. I wrote lots and lots and lots of those kinds of posts in 2008 and 2009. The information is still EXCELLENT for parents as well as professionals. If you’re looking for in-depth information, start there!

Another category I’d like to tell you about is in VIDEOS. I have over 35 short (most are less than 10 to 15 minutes) videos here for free in my Therapy Tip of the Week series. You can also watch those on teachmetotalk.com’s  youtube channel. Most of the videos are ideas for a particular toy or activity. I walk you through how to work with toddlers and young preschoolers with language delays and provide suggestions for goals for each issue you might be working on at home or in therapy.

In 2008 I started a podcast where I host a weekly show about topics related to late talking toddlers. I used to do the show with a co-host and you can still hear those, but now I have guests or it’s just me! The podcast has thousands of listeners, both parents of children with developmental delays and professionals who work with young children with language delays. Scroll through the podcasts until you find show titles that are most applicable for your situation. You may also want to subscribe to the podcast on iTunes and listen from your smart phone or another device.

If you’re looking for resources, I’ve developed a whole line of DVD and therapy manuals to help parents and early intervention therapists. Click here for more information about those products.

If you haven’t signed up for my free eBook, do it now! It’s full of information, particularly for parents who are just beginning to search for answers. You’ll also receive updates and special offers when you subscribe including a coupon code for a nice discount on any teachmetotalk.com product.

Thanks for stopping by, and I hope you find what you’re looking for to help your baby! If not, leave me a comment with your questions, and I’ll try to point you in the right direction.

Laura

——————————————————————————-

More information about Laura

The post New to this Site? appeared first on teachmetotalk.com.

This week we’re going to discuss how to interpret test scores from speech-language evaluations and other standardized and criterion-referenced developmental assessments. This may not be the most interesting topic we’ve ever covered, but I routinely get questions about this on the website, in e-mails, and from parents I work with wondering exactly what it all means.

If you have general questions about results of your child’s testing, we’d love to hear from you! Please call us with your questions or comments. Our call-in number is 1-718-766-4332. We’d love to hear from you!

You can listen live by clicking this icon.

If you can’t join us live, you can always listen later anytime using the blogtalkradio icon in the right hand column or on the home page.

Our show is also available for FREE download on itunes. Visit the itunes store and search “Teach Me to Talk with Laura and Kate.” For you itunes novices, choose subscribe, and the show will download so you can listen later with your ipod.

Hope you’ll join us! Laura

The post Interpreting Test Scores in Toddlers and Preschoolers – “Teach Me To Talk with Laura and Kate” on Thursday, February 12, 2009 appeared first on teachmetotalk.com.

For those of you who may be new to the field of pediatric therapy, let me break it to you, and not so gently. You can’t judge normal by the highest functioning kid on your caseload that you just discharged because he no longer met the eligibility requirements for your agency or program. While you can call a kid “within normal limits” when he barely meets all the skills on the criterion-referenced checklists you’re using, you can’t really reassure his mother that he’s “fine” since those are designed so that kids who barely make it to the shallow end of the bell curve still pass.

You surely can’t judge normal by comparing clients to your own children, if you even have any, unless you have a whole houseful of kids and wonderful genes so that each one of your children is without quirks! To top that off, sometimes a “mother’s love” blinds us to issues with our own children! We can diagnose difficulties in other people’s kids all day long, but some of the worst cases of old fashioned denial that I have encountered professionally have been in families whose parents have the credentials of someone who should?know better!

The only way to make sure you are keeping your finger on the pulse of normal is to see lots of kids and often.

How exactly do you do this? One way is to constantly acquaint yourself with mothers who have children the same ages as kids you treat, or involve yourself in a group with kids the same age. If you’re an elementary school SLP, this might mean that you find yourself a Brownie or Boy Scout troop to befriend. If you’re a preschool therapist, coach a sport at the Y or in your community leagues. Since I specialize in birth to 3, I volunteer in the nursery at my church once a month on Sunday mornings and teach a class of 2- year-old every Wednesday night during the school year.

Churches and community organizations rarely turn down a capable and willing adult volunteer. Just wait until they find out you’re a “professional!” You’ll likely get to?name the time or commitment you’d like to fulfill.

Another “must” that they don’t tell you about in grad school is to commit your milestones to memory. Know them so well that you can quote them verbatim when someone asks, “How many words should my child have by X months of age?” If you’re constantly saying or thinking that you need to “wait until I score the test to see if this child qualifies,” then you don’t know normal well enough. Learn your stuff! The parents of the children you see are counting on you to know!

The post Keeping Your Finger on the Pulse of Normal….Advice for Therapists appeared first on teachmetotalk.com.

How can I find my state’s program?

To find the program for your state, search or Google the phrase “early intervention” and your state’s name. Your child’s pediatrician should also be able to give you the contact information for your state’s program. Or you can go to the following website and click on your state to find information for the Part C (Early Intervention) Coordinator for your state http://www.nectac.org/contact/ptccoord.asp?.

How do I get my child evaluated?

In most states parents can make the initial referral, and all it takes is a phone call. You’ll be assigned a service coordinator or case manager who will walk you through the process and coordinate your child’s evaluation from an early intervention specialist (who is usually a licensed physical or occupational therapist, a speech-language pathologist, or an early childhood education teacher, also called developmental interventionist in my state.)

If your child does qualify for therapy through your state’s program, your services will be free or based on a sliding scale according to your income.

Why seek out services?

Typically, children who participate in early intervention experience significant improvement in development and learning. Research tell us that babies and toddlers with delays or conditions likely to cause delays benefit greatly from services during critical developmental years of birth to 3. Services benefit families by teaching parents what they can do to help their children at home. Support is also provided for parents which results in reducing stress. Early intervention services can also decrease the need for costly special education programs later in life by working on problems early in the child’s development.

How does a child qualify for services?

Child eligibility for the program varies by state but can generally be determined in two ways:

1. By developmental delay – A child may be eligible for services if an evaluation shows that a child is not developing typically in at least one of five skill areas: cognition, communication, physical/motor, social and emotional , or self-help/adaptive skills.
2. Automatic entry – A child may be eligible if he or she receives a diagnosis of physical or mental condition with high probability of resulting developmental delay, such as Down Syndrome.

How are services provided?

Services may be provided in the home, at daycare or preschool, or at a designated center or clinical setting, depending on the needs of the child and family, state requirements, and the availability of services in a given area.

The post How to Find An Early Intervention Program in Your Area appeared first on teachmetotalk.com.

Research tells us that toddlers with typically developing language possess a single-word spontaneous vocabulary of 35-50 words before they begin to combine words into two-word phrases. We should use this same guideline when deciding when to target phrases with children who are late talkers, those with language disorders, and especially in children with apraxia, or motor planning difficulties.

There are many things that you can do at home to work on the prerequisite skills necessary for spontaneous phrase production and to help a child learn to talk in phrases.

1. Before you begin working on two-word combinations, be sure that your toddler is saying at least 35 words on his own (meaning without imitating you) in daily routines.(This point is so important I’m repeating it in case you didn’t process it the first time.)

In my experience, many late talking children, especially those with apraxia, or motor planning issues, have single-word vocabularies well in excess of 50 words before they can begin to consistently imitate two-word phrases, much less say novel ones on their own.

If your child’s vocabulary is not this size, continue to work on adding new single words.

Some children can imitate phrases before they are truly using 50 words on their own. In many cases, they are learning the phrase “holistically” or as one unit. In other words, the entire phrase is just one long word to them. Children with difficulty processing and understanding language often learn phrases in this way.

The only way to know if your child’s vocabulary is at this level is to keep a list of all of the words he says on his own (not imitated) over 2 or 3 days. I routinely ask the parents of children on my caseload to do this. Most parents have good luck keeping a running list on the refrigerator or in the den. Sometimes parents are surprised at the results. Some parents underestimate their child’s vocabulary and are excited when they realize just how much he/she is saying. Some are disappointed when they realize their child might be using a core set of words over and over. If you’re not sure how your child is doing, I definitely recommend this exercise.

2. Your child needs to have a variety of words in his vocabulary from different grammatical categories before he can sensibly combine words into phrases.

When analyzing the early vocabularies of toddlers, most of the words they use are nouns/names for people and objects. This is the case in typical language development too. But if you’ll think about it, a child needs more words than nouns, or names for things. It’s hard to make a sensible phrase using two nouns. (Other than those for agent + object such as “Daddy shoe.”)

Children also need:

• Social words (such as bye-bye, hi)
• Requesting words (such as please, more, again)
• Verbs/action words (such as go, eat, sleep, drink, jump, open, push)
• Early pronouns (such as me, mine, my, I, you)
• Prepositions/location words (such as in, out, off, on, up, down, here, there)
• Negation (such as no and then later contractions including don’t, can’t)
• Adjectives & adverbs/descriptive words (such as big, hot, fast, yucky)

Be sure you are introducing and teaching words from these different categories so that your child has broad vocabulary base in order to make phrases.

3. Your child needs to be able to sequence two syllables together.

If your child routinely reduces multisyllabic words to one syllable, such as “ma” for Mama, “bu” for bubble, “Mo” for Elmo, he needs more practice with sequencing syllables first before trying to learn phrases.

Work on this by practicing words with reduplicated or repetitive patterns, since this is the easiest and earliest form noted in typically developing language.  A good example would be the “early” words:  Mama, Dada, bye-bye, baba (for bottle), and night-night. Try to target words with sounds he already tries to say.

Don’t forget animal sounds, since these are more fun to practice, such as moo-moo, baa-baa, neigh-neigh, quack-quack, woof-woof, etc…

Use clapping or patting the floor to help him “feel” both parts of the word. You can model this and wait for him to imitate, or use hand-over-hand assistance to make him do this. This technique is very helpful for children with motor planning problems (apraxia). The motor movements actually help them produce the word. (That’s why signing is so effective too!)

4. Your child needs to be able to say several different types of syllable structures.

This is going to be a little technical to explain, so hang in there with me. Toddlers with typically developing speech and language skills usually learn to say words with various patterns and syllable structures. For example, a toddler who can say Mama, up, no, hot, and open is using 5 different kinds of consonant (C) and vowel (V) combinations.

“Mama” is CVCV.

“Up” is VC.

“No” is CV.

“Hot” is CVC.

“Open” is VCVC if he says “open” or VCV if he says “opu” (a typical way babies say “open.)

If your child can only use one or two syllable types, he is not going to be able to say lots of different phrases. Even if he tries, you may not be able to understand him because it will be “off-target.”

Analyze the kinds of syllable structures your child says by carefully listening to how he says the words. (A word of caution here – new talkers do not need to be constantly corrected for their first word attempts. Do not take this as a license to overcorrect. This should be a process of analysis, not an opportunity to prematurely begin work on articulation!)

Note if most of his words are the same patterns. This is common for children who are late talkers and especially those with apraxia, phonological disorders, dysarthria, or whatever else you want to call it.

If most words are the same pattern, you’re going to have to work on introducing new syllable structures. This requires some thought and careful planning. If you’re not naturally good at it, call in a speech-language pathologist to give you some assistance. (Another word of caution – Your child may not be able to do this without special coaching, and you may not be able to teach him. Don’t despair if you can’t get him to pronounce a new pattern. I had to go to college for 6 years to learn how to do it!)

For children who did not babble or produce jargon (saying short syllable strings with inflection similar to adult speech), this step may be unrealistic for a while, since difficulty with verbal sequencing is likely the reason he is talking late. Some therapists try to teach kids to babble or jargon by modeling this for them. I must confess that I am horrible at this!

Instead, I sing to them using very familiar songs. Singing is the best way to practice sequencing because we get help from the melodic (the technical term is “prosodic”) qualities of speech. Remember all the advice about using a “sing-song” kind of voice from the What Works article? It’s the same idea. I encourage kids to sing by “bouncing” or dancing during singing. Sometimes I just hum the song to get them going. You could also use a single syllable he can say and repeat it to the tune of a familiar song. There’s more about the benefits of singing later in this article.

5. Your child needs to hear a variety of two-word phrases before he is able to imitate them.

What can you do to work on this at home? Frequently model short two-word phrases during the day. Try to vary your categories too. (See #2 above if you’ve forgotten this already!) Don’t get stuck always modeling Noun + Verb:  “Mommy sees.” “Blocks fall.” “(Name) eats.”

Vary the way you model phrases.

• Verb + Noun – “Read book,” or “Eat cookie.”
• Pronoun + Verb – “I run.”
• Pronoun + Noun – “My shoe,” or “You(r) turn.”
• Adjective + Noun – “Yucky milk.”
• Noun + Preposition – “Arm in.”

Expand his single words to phrases and repeat these to him.

• When he says, “Car” to ask for a car, you model, “Want car.”
• When he sees a car and is labeling “car,” you model, “There’s car.”
• When he’s making the car move, you model, “Go car.”
• When you are playing cars with him, take it from him and teasingly model, “My car.”

Remember that lots of the language directed to a late-talking toddler should be at or just above his expressive language level. For new talkers, you should be using mostly single words and short, two-word phrase utterances when you’re talking directly to them in play and in daily routines.

6. Your child should be able to imitate two-word phrases before he can consistently produce them on his own.

(Okay – here’s another disclaimer:  Sometimes kids with apraxia can say phrases on their own initially better than they can imitate them due to the difficulty with imitating anything, especially a challenging sound sequence, which usually includes phrases.)

Teach phrase patterns so he has a model of what words to combine. Use predictable patterns for extra practice, since motor planning will be easier if one word is changed.

The ones I start with first are:

More + (Noun he says frequently) (Noun he says frequently) + please More + please Bye-bye + (Name/noun he says frequently)

If your child has used sign language, it may be helpful to model the sign as you are saying the word.

Even if your child has “dropped” signs in lieu of words, you may want to pull them out again as a strategy to help him “motor plan” for phrases.

Another way I use signs at this level is for me to sign the word, but not say it, as a cue to help the child know what to say. If he can’t do it without a verbal cue, I mouth or even whisper the word. Sometimes kids can even say a phrase in unison with me, but not repeat it. If your child is interrupting you while you are modeling, he’s indicating that this technique will work for him, especially if he’s doesn’t “finish” the phrase without you.

One mistake many people (including therapists) make when practicing phrases is to break up the phrase into single words. For example, they have the child repeat, “more,” then “milk.” This is okay one time, or perhaps two, but please resist the urge to split up phrases every time you practice! This defeats your purpose! Model the phrase with the words together. You already know he can say single words. You’re working on phrases!

If a child keeps repeating the first or second word as the phrase, such as “ball ball” for cheese ball, he is having difficulty with motor planning. Keep using these strategies. He needs them!

Another thing I do is to model the phrase using a sing-song tone of voice. Again, this helps with motor planning/programming because of the rhythm and prosodic (melodic) qualities. Your kid won’t sound like this forever, but doing this now may give him a shot at being able to produce phrases sooner.

When he’s imitating those well, move on to other patterns including:

Hi + Name/Noun Night-night + Name/Noun

(For you purists out there, “good night” is usually too hard!)

When he’s doing these well, I listen for words he says frequently to model and prompt as phrases.

If he says, “go” and “choo-choo,” I model the phrase both ways to see what’s easier for him to imitate: “Go choo-choo,” or “Choo-choo go.” I always keep these kinds of “probes” in context too. Don’t sit down with your word list while he’s having a snack and try to see what he can imitate. Keep it real!

7. Some kids need an “in-between” step when making the leap from single words to two-word phrases.

Some kids need that extra practice with sequencing before they are able to try phrases. I like to use the same word for this kind of practice. Use words in a repetitive pattern like “up, up, up.” Location words/prepositions and verbs/action words usually lend themselves better to this kind of practice. Try, “Walk, walk, walk,” as you’re walking or making an animal walk in play. Try, “Down, down, down,” when you’re going doing the stairs.

Another way I practice is to label pictures in a book or toys placed in a line on the floor sequentially. (This is a great way to work in a language focus for kids who line up all their toys!) Start with all of the same kinds of objects. For example, if he’s lined up all his trains, point to each one and say, “Choo-choo, choo-choo, choo-choo.”

Instead of counting objects or pictures of like items, I practice labeling them. For example, in a counting book with a picture of a group of dogs, I point to each one and say, “Dog, dog, dog.”

I also practice with different pictures or objects in play when a child’s sequencing is better. Try to stick with words she can already say. For example, when playing with dolls, place a few items in a row and label, “Baby, milk, sock.” Pause between words, but not for too long or you’ll defeat the purpose of practicing to improve sequencing.

8. Take advantage of “automatic” speech.

When something is familiar to us, it becomes “automatic.” When you’ve heard something over and over again, your brain “recognizes” and “predicts” the next part. Use this with your child.

One way to practice this is with books with repetitive themes. Look for ones with a tag line that’s repeated over and over. Again, make sure this makes sense to your toddler.

Another way to practice this is by singing familiar songs. When your child has heard a song many times, his brain begins to expect what comes next. You can use this to get new words by singing a line from the song and pausing for him to complete the next word. Toddlers usually do this best when you leave the blank at the end of the phrase. For example, sing, “Row, row, row your” and wait for your child to sing, “Boat.” This works best when it’s an age-appropriate word. The next line in this song illustrates my point. “Gently down the _______.” I don’t know a two-year old with typically developing language skills who says, “Stream” in everyday conversation. Be sure you’re using common sense in choosing which words you expect him to say.

When you’re singing, be sure to slow down the rate so he has time to catch up. This is the main reason you should sing, and not rely on CDs. You can control the speed! Some children’s CDs and toys sing so fast that I can’t even keep up.

Don’t forget to try other familiar sequential phrases such as, “Ready…” and pause for him to say, “Set… Go!” Say, “1…” and wait for him to say, “2 … 3!” Make up your own cute phrases at home during daily routines and say them over and over so your toddler expects what’s coming next. We had lots of these in our house (and still do!)

9. Try holistic phrases if your toddler is really struggling.

As a rule, I don’t model very many of these unless I don’t think I can get phrases any other way. Sometimes children with apraxia can imitate or “pop out” a holistic phrase and then it becomes part of their core vocabulary. Good ones to try are:

I did it!                 I got it!                 There it is!          Here you go!

See ya!         Where (did it) go?           Right there/ Right here                That one/ This one

No way!               Oh man!              Gimme 5!

I also try funny, novel sequences such as, “Oooh – Yuck,” “Uh-oh Spaghettios,” or “Oopsy daisy,” to help move sequencing along if I’m not having any luck with more traditional combinations.

10. Listen for any “pop out” phrases and try to elicit them again in similar situations.

Pay attention to any “accidental” phrase he might use and try to get your little guy to say it again. You may have to set up the same situation later to see if lightning will strike twice. Remember that repetition is what increases the strength of your child’s brain’s motor pathways or connections for speech. Do all you can to help your child be able to say the phrase again, without lots of obvious pressure. Sometimes, the more you push, the harder it is for him! Set up the situation and wait (and hope and pray!)

11. Try carrier phrases.

Use simple phrases with the same words at the beginning so that your toddler only has to “plan” to change one word at a time. For example,

There’s a ___________.

That’s a ____________.

I see a _____________.

I want _____________.

I like ______________.

Give me ____________.

Don’t begin carrier phrases too soon!! I wait until I hear many other two-word phrases before moving to these 3 to 4 word phrases. Lots of SLPs, particularly those who have previously worked with older children, begin here with toddlers and it’s always a mistake! Wait and introduce these phrases once other patterns are more consistent.

I hope these ideas help! If you need clarification, please feel free to leave a question or comment! I’d love to hear from you! Laura

———————————————————————————————————————–

If you’re a parent and want to SEE a child move from words to phrases, there are excellent examples with real-life late talkers in my DVD Teach Me To Talk.

If you’re an SLP, there’s an expanded version of this article in the expressive chapter of Teach Me To Talk: The Therapy Manual.

When you’d like to coordinate your total approach and walk a nonverbal toddler all the way from sounds to words, check out my book Building Verbal Imitation in Toddlers. The CE course for therapists with this material is Steps to Building Verbal Imitation in Toddlers.

The post Making the Leap from Words to Phrases…. Tips for Helping Your Toddler Learn to Combine Words appeared first on teachmetotalk.com.

• Repeating or the last few words of the question rather than answering
• Answering incorrectly such as shaking their heads yes when you ask them a question with 2 choices
• Giving an off-target response such as answering, “Two,” when you ask, What’s your name?
• Not responding or ignoring questions

By 30 months of age, most toddlers with typically developing language skills are consistently answering yes/no questions, choosing between 2 options (“Do you want your Dora shirt or flower shirt?”) and answering simple “What” and “Where” questions (“What do you want to eat?” or “Where did Daddy go?”).

By age 3 most children with typically developing language skills correctly answer common questions related to themselves such as, “What’s your name,” “How old are you,” and” Are you a boy or a girl?”

Listed below are the tried and true ways I recommend that parents work on answering questions with their children at home.

Basic Questions

Children learn to answer, “What’s that?” questions to label items before they begin to answer other kinds of questions. If your child is not consistently answering this question, practice often with words you know he can say across different contexts. For example, if says, “Shoe,” ask him, “What’s that?” while pointing to his shoes, while looking at pictures of shoes in catalogs or magazines, while reading books, and while playing with a doll or toy characters.

Toddlers also begin to answer questions by making verbal choices. Offer choices for everything throughout the day. “Do you want milk or juice? Which one should we play -blocks or cars? Should we read Good Night Moon or the Elmo book? Do you want a hug or a kiss? Does the cow want to eat or sleep?” If he is not yet using words, he can respond with a gesture such as pointing, looking, or even grabbing the one he wants. When he is talking or signing, you should wait him out for a verbal response, especially for words you know he can say or sign.

One way to make sure that your toddler understands choosing is to offer a non-preferred item as a choice. This is an especially effective technique for children who only “echo” the last words they hear. For example, ask if he wants to play with bubbles or a sock. If he repeats “sock,” make him take the sock. You can also use this with favorite snacks and a not-so-desirable option. If he echoes and says the wrong item, make an effort to have him take the item he doesn’t want, even if he’s initially upset or confused. Give him a second chance by saying, “You said, ____. What do you want, ______ or _____?”  Sometimes I hold the “correct” choice forward or shake it to call attention to it. I also the exaggerate the “preferred” item as I say the word and whisper the non-preferred choice.

Ask early “where” questions that she can “answer” with a point, look, or by retrieving an item. For example, hide a ball in your hand and ask her where it is. Ask her where common objects are in your home so that she can go get them. Ask her to locate family members by pointing or looking as you are seated around the table during meals. Have Dad or an older child model the correct answers as you ask your child. Practice these kinds of tasks often knowing that you are building a foundation for verbal responses.

When your child correctly “answers” with a non-verbal response, use words to describe what he did. As he’s pointing to family members when you’re asking, “Where’s _______,” say the family member’s name or a response such as, “Right there.” When he’s answering a location questions, use the correct words.? “Yes! It’s in the box.”

Moving On

Work on yes/no questions by giving them as “choices.” For example, “Do you want cookies – yes or no?”  Shake or nod your head to cue your child as you say the words “yes” and “no” so that he can associate those gestures with words and use them if he can’t or won’t say the words just yet.

When he’s answering “where” questions accurately without words, begin to model verbal responses by giving two choices for more complex questions. Say, “Is your hat on your head or on your feet?” “Is the ball on the couch or the floor?”  “Is the dog eating or sleeping?” Again, use visual cues to help him.  I use an exaggerated point to help cue the correct answer.

Higher Level Questions

For answering questions about recent experiences, use the choice method or the review method. Ask her, “What did you do at school today?”

Use the choice method to help generate an answer if she doesn’t respond to your first attempts. Try, “Did you paint or play in sand?” Again try to vary the order of your choices so she is listening for the “correct” answer. (A little foreknowledge of what she actually did is required for this to be effective!)

Practice the review method in daily routines and especially at the ends of specific play times. Narrate what you did and then ask questions. For example, “Today we played with the farm, ate Oreos, and blew whistles.” Then ask her what you did giving visual cues (pointing or holding up the objects) as she answers.

When you come in from playing outside, have her tell Dad what she did. Start with a review of activities by saying, “We played on the slide and then on the swings.” Then have Dad ask, “What did you play?” Model what she should answer if she can’t do it.

Another great time to practice is at meals. Review what she ate for dinner by saying, “You ate chicken, macaroni, and peas.” Then ask, “What did you eat for dinner?” Point to her foods as a cue of what to respond. Fade the review and pointing when she begins to answer on her own.

A very effective way to cue answers to questions is to have one adult “ask” the child questions and have another adult “whisper” the answers if he needs help. Fade the coaching as he becomes better.

For children with better language comprehension skills who understand humor, try using a ridiculous choice to entice her to respond without echoing. You might say, “Do want to eat ice cream or poop” Exaggerate the silliness of your offer so she knows you’re kidding and gets the “humor” in this question. (Beware the “poop” jokes. This may catch on and be a loooong phase at your house!)

For learning to answer the familiar name/age/gender questions, practice, practice, practice. A good way to begin working on this is to ask older children first so that your child can hear a model and it becomes a game. I also ask these questions with “yes/no” choices too. “Is your name Daddy/sibling’s name/pet name/character name?” Model an exaggerated, “Noooooo” with a big head shake and grin.  Ask a couple of “no” responses, then ask the correct version.

To help children learn gender, label “boy/girl” everywhere you go. I also use children’s clothing magazines with stereotypical pictures such as girls in dresses and with long hair and boys in pants since there are lots of pictures for practice. Be sure to?”teach” this concept for a long time before you begin “testing” by asking, “Is he a boy or a girl?”  You don’t want to let a child repeatedly make a mistake in answering since he then “over-learns” the incorrect response. Gender is often a difficult concept for children with language delays.

If you have any other “tricks” for teaching your child to answer questions, please feel free to share them with us by leaving a comment! Laura

Need some more help with specific activities to improve a toddler’s language skills? I can provide that for you!! My best-selling book Teach Me To Talk: The Therapy Manual is full of ideas!

The post Teaching Your Toddler to Answer Questions – Receptive and Expressive Language Delay Issues appeared first on teachmetotalk.com.

There are between three and six million children in the United States with speech or language disorders. As a pediatric speech-language pathologist specializing in early intervention, I work with children between birth and three years of age. When I evaluate a child, after confirming parents’ suspicions that there is a definitive problem, the next question is usually some version of, “Why?”

Sometimes we don’t know exactly why a child isn’t talking yet at two or three. Many professionals err on the side of caution and label all children they evaluate as “delayed,” when in fact they aren’t yet sure what the exact problem is. It is often difficult to pinpoint an exact diagnosis during the first visit or two (or 10!) with a toddler, but there are many common communication difficulties in this age group.

Let’s also clarify the difference between the terms “delay” and “disorder.” A delay means there’s just a problem with the rate of development. Skills are coming in as expected, but it’s just slower than when other children acquire the milestones. Most of the time (unless a professional is misusing terminology) a “delay” implies that there’s a reasonable expectation that a child can “catch up.” Intervention, whether it’s more informal at home with parents who are committed to implementing new strategies, or whether it’s more formal with enrolling a child in therapy services, certainly helps increase the likelihood of improvement.

When there’s a disorder, it means that development is somehow atypical. The rate may also be slow, but there abnormalities present that are not seen in children with typically developing skills. Disorders, by their nature, are more serious than delays and always warrant professional intervention. For example, autism is not a developmental delay, but a developmental disorder.

Below is a list of the most common types of speech disorders and diagnoses associated with pediatric speech-language problems with a basic explanation for each. Please remember that this is a listing of specific speech-language diagnoses and not necessarily a medical or educational label. For example, a child diagnosed with autism may exhibit characteristics of apraxia, a child with Down syndrome may have dysarthria, a child with dyslexia may also have an auditory processing disorder, etc…

The speech-language diagnosis may be just a part of a condition that affects a child’s overall developmental picture, or it could be the only issue a child faces. I have often evaluated children whose parents referred them for what they thought was a speech or language delay, when in fact their children were exhibiting delays in other developmental domains as well. This also happens with other disciplines too. My colleagues who are physical and occupational therapists often end up referring children for communication assessments when parents initially sought their help for what they assumed was just “late walking” or “difficulty with feeding,” not realizing that their child was behind in other areas too. Many children with developmental difficulties have issues that overlap the motor, social, cognitive, adaptive, and communication domains.

When in doubt, get an evaluation. Be sure to ask the professional if there are other developmental concerns as well. You’d rather know, and the sooner, the better. All of the current research tells us that early intervention gives a child the best chance of minimizing long-term difficulties. Waiting until your child is school-age to see if he will “outgrow” a problem puts him at a serious disadvantage, especially when it comes to communication difficulties.

Types of Communication Delays and Disorders in Toddlers

Apraxia

Apraxia is a neurological speech disorder that affects a child’s ability to plan, execute, and sequence the movements of the mouth necessary for intelligible speech. Apraxia can also be referred to as developmental verbal apraxia, childhood apraxia of speech, or verbal dyspraxia. Most SLPs use the terms interchangeably. Characteristics of apraxia include:

• Limited babbling during infancy… these are quiet babies.
• Few or no words when other babies are talking by age two.
• Poor ability to imitate sounds and words.
• Child substitutes and/or omits vowel and consonant sounds in words. Errors with vowel sounds are not common with other speech disorders.
• His word attempts are “off-target” and may not be understood even by parents.
• He may use a sound (such as “da”) for everything.
• Often his errors are inconsistent, or he may be able to say a word once and then never again.
• The child understands much more than he can say.
• There is sometimes (but not always) a family history of communication difficulty. (i.e. “All the boys in our family talk late,” or “My husband’s grandfather still has trouble pronouncing some hard words.”)

There has been controversy in the field of speech-language pathology in giving this diagnosis to children under three. However, the kinds of therapy useful for children with apraxia are often not introduced if the clinician does not suspect this as the root cause for a child’s communication difficulty. If you suspect this is your child’s problem, initiate a conversation with your child’s pediatrician and begin speech therapy with an SLP with experience treating apraxia. If your therapist says that he/she does not believe that this can be considered before age three, look for a new therapist!

An excellent resource for parents and professionals working with children with apraxia is www.apraxia-kids.org. Another comprehensive resource for an explanation of apraxia can be found here.

Many children with apraxia also have difficulty with sensory integration, or how he processes information from all his senses including visual, auditory, tactile, and proprioceptive (or movement) skills.

Feeding issues are sometimes present because of the sensory issues that a child exhibits. For example, he may have poor awareness in his mouth so that he overstuffs to “feel” the food, or to the other extreme, he is so sensitive that he gags when new textures are introduced.

For more answers to a parent’s questions about apraxia on this site, look at posts in the Apraxia section.

Phonological Disorders

A phonological disorder is a difficulty with the “rules” or “patterns” for combining sounds intelligibly. For example, phonological process patterns include prevocalic consonant deletion (leaving off consonant sounds that precede a vowel such as “at” for hat), syllable reduction (producing only one syllable in a multisyllabic word such as “bay” for baby), or reduplication (simplifying a multisyllabic word to a duplicated pattern such as saying “bubu” for bubble or even “dog dog” for doggie.)

There are many patterns for analyzing a child’s speech according to a phonological processes model. All of these processes are common in typically developing children as well. It becomes a problem when a child is not maturing in their patterns of production when most other children are.  For example, final consonant deletion (leaving off ending consonant sounds in words) typically disappears between two and one-half to three years of age. If a child is not including final consonants by the time he reaches 3, it would be considered “disordered” or “atypical,” since most of his same-age peers are now using a more mature pattern.

A child with just a phonological disorder exhibits typically developing language, meaning that his vocabulary and utterance length are the same as his peers, but he continues to exhibit patterns that are consistent with a younger child’s speech errors. He sounds younger than he is. A child with a phonological disorder needs speech therapy to learn new patterns. The most popular approach for therapy for this disorder is the Hodson Cycles Approach. A pattern is targeted in therapy for a certain number of sessions, and then a new pattern is initiated. Once all of the patterns are addressed, the cycle starts over. Your child’s speech sounds begin to improve, even if it’s not “perfect” through the first few cycles. This approach has lots of research to support it. It’s generally used for highly unintelligible kids over three. For more information on this approach, ask your child’s SLP if it’s right for your child because even the veterans know and use this technique.

Articulation Disorders

An articulation disorder is a difficulty with the production or pronunciation of speech sounds. This difficulty may be present with an isolated sound such as substituting /w/ for /r/, difficulty with blends such as “st,”or with distortion of sounds such as a lisp. Sometimes clinicians speak of phonological disorders and articulation disorders interchangeably. I use the term “phonological disorder” when there seems to be a difficulty with attaining a “pattern” of sounds and the term “articulation disorder” when a child has difficulty with only a couple of sounds rather than an identifiable pattern. If a child is still exhibiting errors with even a few sounds after most of his peers can correctly use the sound, he needs therapy to help him. For a list of ages when children acquire certain sounds, try this chart.

Language Processing or Auditory Processing Disorder

A language processing or auditory processing disorder is difficulty listening to, receiving, analyzing, organizing, storing, and retrieving information. It can also be called “central auditory processing disorder” (CAPD). In young children, this often looks like the child cannot understand what’s been said to him, even when his hearing and language comprehension skills are within normal limits. A child may have difficulty paying attention to what someone is saying to him or have difficulty following directions in the presence of background noise, or when he’s more focused on something else. This might be the kid that won’t look away from his favorite TV program when a bomb goes off, much less when you’re calling his name.

This is commonly included as a receptive language disorder in children under three, with an official diagnosis of auditory processing disorder coming later in the preschool or early school-age years since there are no tests for this condition with younger children. Children with sensory integration differences also exhibit auditory processing disorders. It’s very common for children with autism and other learning disabilities, such as dyslexia and attention deficit disorder, to exhibit these characteristics as well. I could not find a site for information for very young children with an auditory processing disorder, but this is receiving lots of attention in the field of early intervention right now, so maybe we should have a good resource soon.

Dysarthria

Dysarthria is a neurological speech disorder that affects a child’s muscle tone. Weakness is noted in the muscles used for speech – lips, tongue, soft palate, and cheeks – so that his speech sounds slurred. Dysarthria is present in kids with Down syndrome, cerebral palsy, or any other condition that causes “low tone.” Dysarthria may also affect a child’s vocal and respiratory quality so that he sounds hoarse or breathy.

A child may also have feeding problems due to muscle tone issues:   difficulty sucking from a bottle because his tongue isn’t strong enough, keeping foods or liquids in his mouth because his lips aren’t strong, or chewing because of overall weakness in his jaws and cheeks. A child may also drool because she can’t close her mouth consistently.

A child with muscle tone issues may also have difficulty with gross and fine motor skills. Physical and occupational therapy may be necessary to help meet milestones. Low muscle tone never truly “goes away,” and there’s a difference between strength and tone. All of us have varying degrees of muscle tone ranging from high to low, and kids with even very low muscle tone can learn to walk and talk.

For a list of signs/symptoms, go to the link here.

Dysfluency

Dysfluency is the more professional term for stuttering. It is the repetition of individual speech sounds, usually at the beginning of words or phrases. Many children with typically developing language “stutter” when they move from using single words and short phrases to longer sentences, and/or when they are under pressure to speak and can’t encode their words quickly enough. Typical dysfluency can occur anywhere from ages two to four. If it lasts for more than six months, seek a professional evaluation.

Many times there’s a family history of stuttering, and this is going to be a chronic challenge. Kids who repeat individual sounds at the beginnings of words with facial grimaces or tremors, tense their muscles, blink their eyes repeatedly, or tap their feet are at greater risk for true difficulty with fluency than those who repeat whole words and who don’t seem to be phased physically by this.

The best advice for parents when your child starts to stutter is to ignore it. Do not tell him to slow down, stop and think, or any other comment that you feel might be helpful. Relax his environment and do not put pressure on him to “perform” verbally.  This includes asking too many questions in a row, demanding that he answer silly questions such as, “Did you hit your sister?” when you know he did, or insisting that he sing his new song from preschool for Grandma, Grandpa, and all of your long-lost relatives at Thanksgiving. Don’t interrupt him when he’s talking, even when he’s struggling. This may be hard, but it is important!

Our oldest son had a terrible several- month bout with stuttering while I was in grad school taking the class on dysfluency. It was horrible for me!! My professor’s advice was simple -“Ignore it and it will (probably) go away.” Another piece of advice is to make sure his teachers at preschool, sitters, or even family members are on board with the “ignore it” method so that no one calls attention to this issue. The unnecessary pressure will make it worse, not better, so tell all of your well-meaning friends and family that you are doing this one your way.

Expressive Language Disorder

An expressive language disorder is present when a child is not meeting milestones in the area of language usually involving vocabulary, combining words into phrases, and beginning to use the early markings of grammar. A child with only an expressive language disorder doesn’t have difficulty pronouncing the words per se, but he has difficulty learning or retrieving new words and putting sentences together. A child may rely on non-specific words such as “that” and “there” rather than learning specific names for objects. She may have difficulty learning verb tenses (such as the “ing” for walking and “ed” for jumped) or have difficulty learning word classes such as prepositions or pronouns.

An expressive language disorder can, and often do, co-exist with a speech disorder such as apraxia. I have treated kids like this with only expressive language delays/disorders, but more often than not, late talkers exhibit a speech AND a language disorder. Sometimes, children exhibit receptive language disorders as well, so it’s not uncommon to have several speech-language diagnoses at the same time.

An expressive language delay would be a child who is acquiring vocabulary, combing words, and learning early grammar with the same sequence as his peers, but at a slower rate. If there are atypical characteristics present, such as your child having some skills at a higher age level but still missing many lower age-range skills, it’s called a disorder. Delays are typically easier to overcome, and most kids with delays eventually catch up. A disorder is generally something a child will struggle with for a while, perhaps his entire life.

Receptive Language Disorder

A receptive language disorder is a difficulty understanding language. This is also called an auditory comprehension disorder. Kids who have receptive language disorders don’t follow directions – not because they’re being disobedient, but because they don’t understand what’s being said. They seem to ignore language because words don’t mean anything to them yet. They often hate reading books unless mommy lets them flip through the pictures because it’s all about listening to words which may not make very much sense.

When a kid gets a little better and understands a little more, signs of a receptive language disorder may be that he repeats a question rather than answering it or gives an incorrect response. For example, if you ask a child with a receptive language disorder who has been learning his colors, “What are you drinking?” he’s likely to respond with “Red!” because that’s the color of his cup. If you ask a question such as, “Do you want milk?” she might answer “No,” but then she’ll still get upset when you don’t give her the cup. She doesn’t understand that answering “No” means she doesn’t want it.

I have seen many kids whose parents or daycare teachers label them as “difficult” or a “behavior problem,” when really there’s a major receptive language delay that no one recognizes. Parents often overestimate what their language delayed/disordered child truly understands. This is so sad to me. When everyone decides to work on teaching and helping him understand language BEFORE we expect him to talk and BEFORE we expect him to “obey,” then everyone benefits.  This is especially true for the kid who doesn’t understand why in the world he’s in trouble in the first place, even though his mother says “I told him not to do it!”

Make sure your child’s receptive language skills are addressed or the other speech-language problems are not going to significantly improve. A child who doesn’t understand much really shouldn’t be saying much either. To expect more is simply wrong, and well above what he’s able to realistically accomplish. Most SLPs think of working on receptive language as going hand-in-hand with working on expressive language, and this is absolutely the right way to go. When parents get on board with this approach, wonderful things happen.

I have written many posts about improving receptive language; check out the best one for parents here.

————————————————————————————————————

If you would like specific recommendations for teachmetotalk.com products based on your child’s diagnosis or suspected diagnosis, take a look at this post.

The post Why Can’t My Child Talk? Common Types of Speech and Language Disorders appeared first on teachmetotalk.com.

Social Function Words

more, please, thank you, hi/hello, bye-bye, again, sorry,?uh-oh, yes/uh-huh/okay, no/uh-uh

Common Action Words (Verbs)

eat, drink, go, stop, run, jump, walk, sleep/night-night, wash, kiss, open, close, push, pull, fix, broke, play,want, hug, love, hurt, tickle, give (“gimme”), all gone, all done, dance, help, fall, shake, see, watch, look, sit, stand (up), throw, catch, blow, cry, throw, swing, slide, climb, ride, rock, come (“C’mon”), color/draw

Location Words (Prepositions)

up, down, in, out, off, on, here, there (Plus later ones such as around, under, behind, over at/after age 3)

Descriptive Words (Adjectives/Adverbs)

big, little, hot, cold, loud, quiet, yucky, icky, scary, funny, silly, dirty, clean, gentle, wet, soft, fast, slow, color words (red, blue, yellow, green, pink, orange, purple, black, white, brown) and quantity words (all, none, more, some, rest, plus early number words – especially 1, 2, 3)

Early Pronouns

me, mine, my, I, you, it (Then toward age 3 the gender pronouns such as he, she, him, her )

Just in case you’re wondering, here’s a list of the most common nouns:

ball, book, choo–choo, train, bike, rain, bubbles, car, truck, boat, plane, baby, bowl, spoon, diaper, sock, shoe, shirt, pants, hat, star, flower, house, tree, brush, towel, bath, chair, table, bed, blanket, light, cookie, cracker, chip, cheese, apple, banana, ice cream, cereal (Cheerios/ “O’s”), candy, milk, juice, water, dog, cat, fish, bird, duck, cow, horse, bunny, bear, pig, lion, elephant, giraffe, zebra, monkey, chicken, butterfly, bee, frog, alligator, snake

Plus names for people – Mama, Dada, brother and sister names, pet names, grandparents & other family members, and favorite characters such as Elmo, Dora, Diego,etc…

The post First 100 Words – Advancing Your Toddler’s Vocabulary With Words and Signs appeared first on teachmetotalk.com.

“My 18mo son is not talking as well as my 4yo daughter did at this same age. She was a babblemouth and he doesn’t seem to want to talk at all. I have expressed my concerns with our pediatrician and was told to not be concerned. Family members don’t seem to be interested in the subject at all. I have a few questions for you and I hope you don’t mind. Why should I be concerned about my child learning to talk at a late age? Do all children who start talking at a late age fall behind in school? How can someone tell the difference between a late talker who will catch up on his own, and a child who is not talking and is at risk for later difficulties? If my child is a late talker who will catch up on his own, then he will not need help from a Speech Language Pathologist, right?”

In order to be as thorough as possible, I am going to try to answer eachof your questions separately.

“My 18mo son is not talking as well as my 4yo daughter did at this same age.”

First of all, there are gender differences between boys and girls and as well as differences between first and second born children, and I think you are seeing both of these dynamics in your family. Overall, boys are more likely to talk later and/or have other learning challenges than girls. However, the developmental norms that experts use (including those used here on this site) consider gender differences and use those to devise the “averages” or “norms.”

Many psychologists that study birth order also note that first-borns are likely to be more verbal and are verbal at an earlier age than children born second or later in families. Reasons cited usually include that parents spend more one-on-one time with their first and only children than with their subsequent children.

“I have expressed my concerns with our pediatrician was told not to be concerned.”

This is a very common occurrence. Many times pediatricians take a wait and see approach, and many times parents regret this. Please see my lengthy commentary on this problem under “When to Worry.” If you feel in your heart-of-hearts that there’s truly a problem, there probably is. Parents know more about their children than even the best doctor who only gets a snapshot of your child every few months (and then most of those visits are when he’s at his worst – sick!). You are with him day in and day out, so you are the “expert” concerning him. Trust your own instincts, even if you are in disagreement with your doctor.

I recently evaluated a little boy whose parents were told by his ENT  that beginning speech therapy before 2 1/2 is “crazy.” I beg to differ. There’s usually a difference between a kid referred in for early intervention at or before 2 and a kid who is still not talking at 30+ months. Six months is a long time to wait for a toddler -that’s 1/4 of his whole life! By 2 1/2 the negative patterns and high frustration levels are so much more of a habit than if we had seen a child and his family earlier. It’s the information that parents get from a speech pathologist or other early intervention professional that makes more of a difference than anything in the outcome for the child. Parents can immediately tweak what they are doing everyday at home, in addition to the real “therapy” he gets, and more often than not, the child starts to progress. Waiting doesn’t make much sense to me, especially if you are truly concerned. I have never heard of a parent that regretted pursuing an assessment before 2, and I have heard many that wish they had.

“Do all children who start talking at a late age fall behind in school?”

Not all late talkers end up having academic problems. However, late talking and other developmental problems that weren’t addressed (and many that were) show up in the case histories of children who later struggle in school. There’s so much research that supports the value of early intervention  – defined as the period between birth and 3. The truth is we don’t know which of the children who talk late will end up doing fine and which ones won’t. On the flip side, there are children who talk on time or even early who later fall behind in school. There are many reasons for learning difficulties, and differences in processing language probably account for a larger percentage of problems in school than any other reason related to communication. Experts agree that a child’s language skills at age 3 are the best predictor for future academic success. Watch this podcast for the latest research about late talking.

“How can someone tell the difference between a late talker who will catch up on his own, and a child who is not talking and is at risk for later difficulties?”

No one has a crystal ball and can see the future for any child, but there are indicators and differences between kids who will eventually begin to talk and those who will struggle with communication throughout their preschool years and beyond. One large factor is child’s comprehension level. Is he understanding language? Does he follow verbal directions during your daily routines and perform other cognitive milestones such as pointing to body parts or pictures in books when asked? Kids who don’t understand many words generally don’t say many words – they talk late and the talk less. Make sure he’s understanding you.

On this same note, how is his hearing? Kids who can’t hear don’t talk either. Ask your doctor to refer him for an audiological (hearing) assessment, especially if he’s had ear infections. Your doctor may also be able to do a tympanogram in his office to detect any fluid in his middle ear. Fluid can be present with and without a true infection. You may never know if your child has fluid in his ears because he may not have shown any symptoms of illness such as a fever or obvious pain. Even periodic short term hearing loss, the kind that’s present when a kid has fluid in his middle ear, can create lags in a child’s ability to communicate. Kids with chronic ear infections may not correctly pronounce words because they don’t hear all the sounds. Some children with untreated ear infections seem to learn “not to listen.” To them it sounds like they’re under water half the time, so why bother? Let me also add that undetected hearing loss is much more rare these days since newborn hearing screenings are routine. Many times parents assume their kid can’t hear when he doesn’t respond. Usually a lack of response is related more to a kid’s ability to process language rather than hear.

Another factor is how interactive and communicative your son is without words. How does he let you know what he wants? Does he point and try to talk? Does he try to direct your behavior by pulling you up to assist him when he needs you? Is he playing social games with you and other adults? If he’s not trying to communicate using gestures or is not regularly interactive with you, insist on an immediate referral to a speech-language pathologist or early intervention program. If he is, then keep encouraging him to let you know what he wants, with or without words. Check out some of the other posts for more information about gestures.

Another factor is how vocal he is. Does he have any words? (By 18 months a child should have at least 15 words. Typically developing toddlers use 50.) Does he attempt to make noise when he tries to communicate? Is he babbling or using jargon or unintelligible longer strings of syllables that seem like he’s telling you something, even if you can’t understand? Can he imitate animal or vehicle noises? I have had some very quiet children pop out words “out of the blue,” but usually children make noise before they begin to use words. If he is unusually quiet, go ahead and get a referral now. You’ll need some tricks to get him going and help him find his voice.

Lastly, what is your family history? Do you have other late talkers on your or Dad’s side of the family? This characteristic does have a genetic link and can “run in the family.” Let me also note that knowing that other boys in the family talked late would not be a reason for me to delay pursuing additional help.

If my child is a late talker who will catch up on his own, then he will not need help from a Speech Language Pathologist, right?

If I knew the answer to this one, I’d be really rich because then we could just line up every late talking kid from here to there and I’d lay my hands on them and know…….. But we can’t do that?

The term “late talker” has come to mean anything from a kid who isn’t meeting expressive developmental milestones at 18 months, or 2, or even 3, who does eventually begin to talk. It also applies to kids at 18 months who may not learn to communicate anytime soon, but you don’t know that yet. Again – the truth is, I don’t know if your son will need a professional or not. Neither do you until you get him evaluated.

But in the mean time, there are LOTS of things you can do at home to help him learn to communicate, and that’s what this whole site is about. If you haven’t already, please read through the other posts for ideas for you at home. If you judiciously work on this for another few weeks or even a couple of months and he’s not any closer, please go ahead and discuss it with your doctor again, or better yet, make the call to an early intervention program, children’s hospital, or private clinic yourself. All states are required to provide access to early intervention services for children. Ask your pediatrician’s office who to call, search for it on the Internet, ask around, or look in the phone book. You could also start with your local public school or health dept. and ask who you should call. You don’t want to wait too long if he’s still not talking and you’re still worried. That’s unnecessary guilt, and we mothers have too much other stuff that we heap on ourselves to feel unneccessarily guilty about!

The worst thing that will happen from a referral to a qualified pediatric speech-language pathologist is that she/he will tell you that he’s fine and you’ll have wasted a couple of hours. Or you could find out that he’s still fine, but you’ll get specific things to do at home to move things along. Or you might find out that he needs services, and you’ll feel so much better that you did it now rather than later.

Besides speech therapy with babies is FUN! You’ll learn new ways to play and get great ideas for things to do at home. In most state-funded programs now with the emphasis on natural environments, the therapist comes to your home, so it’s not even that much of a hassle (other than maybe cleaning up around?the house a little bit which most of my families stop doing after they’ve known me for a while). Even if you do have to take him somewhere, it’ll be worth the trip.

Thanks so much for reading this site. I really appreciate your questions, and I hope I’ve answered them. Please let me know if there’s anything else I can do to help!

Here are the resources I recommend to families of late talkers…

Building Verbal Imitation in Toddlers – a book with a step-by-step plan to walk you through teaching your child to imitate words. The chart in the back of the manual has been described as “speech therapy gold” for parents of late talkers to help you remember what you should be working on based on your child’s stage of language development.

Podcast with the Top 5 Strategies I recommend to parents

Let’s Talk About Talking   is a comprehensive therapy manual that will help you determine what’s missing and what you’ll need to teach a toddler before they begin to talk.  All kids master 11 skills before they begin to use words. When one or more or missing, a language delay is guaranteed. The checklists will guide you toward what to work on and it’s filled with explanations and activities for parents and professionals to use with late talking toddlers.

The post Questions about Late Talking appeared first on teachmetotalk.com.

Age Ranges

(If your child cannot perform these skills by the end of the age range, an immediate referral to an early intervention program or speech-language pathologist is warranted.)

(Most children can perform these skills by the end of the age range.In other words, this is “typical” or “normal” development.)

0-3 months

-Communicates with cries, grunts, and facial expressions

-Prefers human voices

-Coos using vowel sounds

-May laugh out loud

-Smiles and coos to initiate and sustain interactions with caregivers

4-6 months

-Vocalizes & coos in response to adults talking or singing

-Blows raspberries

-Smiles in response to pleasant speech

-Begins to babble using consonant-vowel combinations

-Participates in games initiated by adults with smiles, laughter, and vocalizations

-Acquires sounds of native language in babble

-Squeals & laughs out loud

-Recognizes his name

6-9 months

-Vocalizes using different

sounding andtwo syllable combinations

-Begins to imitate duplicated syllables when modeled by an adult (“Mamamama” or “Bubububu”)

-Varies babbling in loudness, pitch, and rhythm

-Adds more consonants sounds to babbling

-May begin to say “mama” or “dada” but may not connect word with parent yet

-Begins to point or use other gestures like reaching to communicate

-Responds to “no” sometimes

9-12 months

-Imitates sounds or words made by others

-Gives objects in response to a request with outstretched hand

-Performs routine activity in response to verbal request (“Put your arm in.”)

-Participates in games such as “So Big” and “Peekaboo” with excitement and performs his part 

-Uses gestures more purposefully to influence the behavior of others

-Understands 25 or more words

-Begins to understand familiar words associated with routines & interests

-Waves bye-bye

-Let him says 5 words on his own

-Imitates other familiar words

-Initiates favorite games with adults

12-15 months

-Tries to say a few words on his own such as “Mama” or “Dada” or exclamatory wordslike “uh-oh” and “no-no”

-Imitates new words & animal sounds

-Performs simple requests such as giving a kiss and waving bye-bye.

-Identifies a few body parts

-Says 10 words on his own consisting mostly of nouns and names

-Understands words and directions associated with familiar routines

-Understands a few early prepositions with cues

15-18 months

-Uses words more often with aminimum of 8-10 word vocabulary

-Echoes last word spoken by an adult

-Names several familiar objects on request

-Points to 6 body parts or clothing items

-Finds familiar objects not in sight on request

-Language explosion occurs by the end of this phase so that he is saying many more words than before

-Normal range of vocabulary is between 15 and 50 words

-Begins to engage in jargon or unintelligible sentence-length utterances

-Begins to imitate two-word phrases & use a few familiar combinations on his own such as “more milk” or “Bye-bye Dada”

-Understands at least 50 words & follows many familiar commands

-Can point to a few familiar pictures on request

18-21 months

-Minimum vocabulary of 15 words

-Names a few pictures

-Points to familiar pictures on request

-Understands 150 words

-Typical vocabulary is 50+ words

-Adds new words everyday

(Some sources say 7-9 new words a day!)

-Uses new & differenttwo-word phrases

21-24 months

-Minimum vocabulary of 50 words

-Saystwo-word phrases on his own

-Follows many different and new verbal directions

-Speaks in 2-3 word phrases frequently

-Refers to himself by name

-Comprehends 300 words & can follow two-step related commands

-Vocabulary size is around 200 words he says on his own

-Is understood at least 25% of the time by parents

-Uses many different consonant sounds and all vowel sounds correctly

24-27 months

-Sings phrases of songs

-Names objects in photographs

-Begins to use a few action words/verbs

-Can point to more complex ideas in pictures (“Who is running”?)

-Uses 3 word phrases frequently

-Understands size concepts

-Understands concept of one

27-30 months

-Speaks in short phrases most of the time

-Parents understand at least 50% of what he says

-Names colors

-Consistently refers to himself using a pronoun

-Follows more complex verbal commands

30-33 months

-Uses plurals (books, shoes)

-Uses prepositions (in, on, out, off, up, down)

-Understands and correctly states gender (Are you a boy/girl?)

-States first and last name

-Uses negation (not sleeping)

-Understands size differences (big/little)

-Understands object functions (Which one do you wear on your feet?)

-Speaks in 4-5 word sentences more often.

-Starts to take more turns talking in early conversations

33-36 months

-Uses verb forms (-ing)

-Asks & Answers Who, what, where questions

-Counts to 3

-Recites a few nursery rhymes/songs

-Identifies parts of an objects

(Show me the wheels on the car.)

-Vocabulary increases to 300+ words

-Is understood by parents 90% of the time

-Uses 4-5 word sentences consistently with correct word order.

– Displays effective conversational skills such as asking and answering many kinds of questions including list to the left and “How”and “Why”

-Refers to himself using pronouns in sentences

-Understands and correctly uses gender pronouns (he/she,him/her)

-Talks about objects and events not immediately present

-Narrates & pretends with more elaborate pretend play schemes (going to doctor or shopping)

?

The post Are My Child’s Language Skills Normal? Compare your child to the standards listed below. appeared first on teachmetotalk.com.

As a pediatric speech-language pathologist, I often get referral information for a child with the primary concern listed as “speech delay” or “communication delay.” These are often catch-all terms that can mean a child is not saying as many words as other babies his age, is talking but is hard to understand, doesn’t follow directions, or is even in his own world and is not interacting well with his parents.

The word “communication” encompasses all of these areas. It includes toddler’s ability to understand and produce words. It includes a baby’s ability to use gestures, such as pointing and facial expressions, to convey his message. To a greater degree than you may realize, it also includes how curious he is about his world, how he plays, and how he tries to interact with others. All of these communication skills can be broken down into smaller, more specific areas. These areas are listed below, along with various terms you might also hear or read concerning communication skills. Each of these categories is important in determining your baby’s overall ability to communicate.

Speech-language pathologists typically separate communication skills into speech skills (actual sound production skills) and language skills (the vocabulary one uses and understands.) When referring to early communication skills, language is usually the area emphasized – and rightly so. While sound production skills are necessary to eventually speak (you have to be able to produce sounds to say words) elevating their importance above language is usually a mistake with toddlers. More commonly than not, it’s a child’s language delays that account for his not talking or understanding, rather than his ability to produce sounds. Focusing on speech sound production for a baby who is trying to talk, but doesn’t speak perfectly yet, can also be a mistake. For example, a child who says “mi” for milk at one year old, and even to age two, should not be overtly corrected for not producing the ending sounds on the word, but more about that in a later post.

LANGUAGE SKILLS

Language skills are generally broken down into two broad categories: receptive language and expressive language.

Receptive Language

Receptive language can also be referred to as “Language Comprehension” or “Auditory Comprehension Skills.”  This means how your baby understands the language he hears. Examples of receptive language include how well your baby follows directions such as “Give me your cup” or how he might start to walk toward the bathroom when you announce, “It’s time for a bath. “ These skills begin from birth when your baby begins to purposefully look at you and enjoy your attention and continue as he starts to notice environmental sounds, such as the neighbor’s dog barking or a loud fire engine. It progresses when he begins to pay attention to what you’re talking about so that he looks around when you announce “Daddy’s home!” or watches as you point to a bird outside the window. He begins to understand early games such as “Peek-a-boo” well enough to cover his head himself and lights up when he pulls the blanket off and you yell “Boo!“ It includes being able to point to body parts when you ask, “Where’s your nose?” and find pictures in books when you say, “Show me the dog.”

Receptive language is closely tied to a baby’s cognitive – or thinking – skills. Until a child is age 3 or older, it is very difficult to separate receptive language and cognition. In fact, most of the skills listed on early developmental charts are actually the same or similar for both domains. Some children may demonstrate cognitive strengths, such as a good memory or exceptional visual skills, so that they recognize written words or can match colors.  However, more often than not, poor language comprehension skills are linked to at least the potential for future academic problems. This is why language skills are believed to be the most reliable predictor for future success in school.  Problems with language skills are also the number one reason kids aren’t ready for kindergarten.

When assessing receptive language at home, it is very important to be sure that your child is responding to the words you’re saying and not the nonverbal cues you might be giving. For example, when you’re asking your child, “Give me the block,” he may be responding to your outstretched hand as he gives it to you, or he may see the juice box you’re getting out of the refrigerator rather than understand, “Are you thirsty?”

Expressive Language

Expressive language means what your child communicates with words he says or gestures he uses. This is most often what parents are referring to when they are concerned about their baby’s ability to communicate. Again, skills in this area develop much sooner than when your baby says his first words. They begin when he cries during the middle of the night for a feeding, and when he gurgles back at you when you are holding him close and calling his name. These skills progress to how he excitedly kicks his arms and legs when you sing to him. As an older baby, he expresses himself when he fusses and pushes you away when you are interrupting his play to change his diaper. This expands to a whine and persistent “Uh uh uh” when he reaches up to the counter for his cup. He learns to wave when grandma leaves usually before he begins to echo, “Bye bye.” These early gestures are an essential prerequisite for expressive language development.

SPEECH SKILLS

Speech skills are the sounds a child produces and combines into words. Speech-language pathologists (SLP) can take a couple of different approaches to analyzing a child’s speech sound skills, or articulation skills, as more commonly noted in evaluation. Clinicians analyze the specific consonant and vowel sounds a child produces correctly alone, or in isolation, and then further assess a child’s ability to correctly combine these sounds into syllables and words at the beginning (initial), middle (medial), and ending (final) positions in words.

An SLP may take a broader look and analyze the patterns a child uses to form words, or phonological processing. This might include leaving off syllables in words such as “na” for banana, or leaving off all ending sounds so that “ba” means ball, box, and bottle, depending on the context.

More often than not, a parent’s chief concern regarding his or her child’s speech skills is simple. They want to be able to know what their child is saying, and often more importantly, they want the all-important others (grandparents, sitters, neighbors, and friends) to be able to understand him too. This is often referred to as how “intelligible” a child is.

OTHER AREAS

As mentioned in the opening paragraph, there are other essential skills a baby needs to be able to communicate. A child must be social, or have a desire to be with and interact with others. A toddler must be learning throughout his day and want to explore a variety of play interests. He should not be stuck in such spinning all his toys, repetitively pushing buttons on and off his light and sound toys, or preferring to watch TV to the exclusion of other types of play. A baby must have learned important cognitive concepts such as object permanence (something doesn’t go away just because I can’t see it) and cause-and-effect (if I push this button, the jack in the box opens.)  He must be able to pay attention to something and more importantly, someone, for more than a fleeting few seconds. This includes consistently making and maintaining eye contact and enjoying back and forth play with adults. Play skills are also important. Early pretending and playing with two toys together, such as feeding a doll with a spoon, are important precursors to language. Imitation is HUGE skill for babies to master because imitation is the way we learn just about everything we know in our lives. Imitation includes learning to hold up hands during a game of “So Big,” learning to clap when we’ve done something great, and babbling back to Mom as she says “Mama, mama.”

How do all these skills work together?

All of these skills are essential to helping kids learn to communicate. While child specialists tell you that all kids develop differently, generally language development follows the same pattern.  There is some variance here and there on the rate or when a specific skill is obtained. For example, on most checklists, skills are listed for an age range, say six to nine months, rather than a certain date like seven months. This is how all of those charts were developed in the first place, and how tests are standardized. Thousands of children are studied to determine when a certain skill is mastered, and then it’s listed on the chart in a range.

There are also some other factors that are fairly predictable. Receptive language generally precedes expressive language. This makes sense because, most of the time, we have to understand something before we can talk about it. There are, of course, exceptions to every rule. This does not include children who mimic everything they hear or when speaking seems to be a child’s gift – for instance, when she can recite lines from a movie, but not understand how to ask for what she needs. The ability to babble or vocalize using a variety of sounds generally comes before a child begins to say real words. Usually a child is speaking in words before they begin to combine them to phrases and sentences.

Don’t even get me started on the Einstein theory that a child can be non-verbal one day and wake up speaking in full sentences the next. This may happen RARELY, but please don’t count on it! There are only a FEW folks with even the genetically predetermined possibility of reaching the cognitive capacity to be Einstein, so unless your family tree is full of Noble-prize winning physicists and world-renowned surgeons, this is probably not going to be the case for your little one. That’s not to say that intellectually mediocre parents can’t produce whoppingly intelligent children, but this is truly the exception rather than the rule.

When your child’s language skills are moving along at a slower rate than would be expected, but the same skills are achieved in the same expected order, it is called a speech or language delay. When your child is not acquiring skills in the same way as expected (for instance, he may have some skills at higher age levels with many skills absent at a younger age level) or if there is no pattern per se in his development or if there are a typical characteristics present, it is called a speech or language disorder. Delays are typically easier to overcome and eventually catch up. A disorder is generally something a child will struggle with for a while, perhaps his entire life.

Now after reading all of this you may feel overwhelmed, defeated, or even scared out of your mind. Take a deep breath and realize that your child has his whole life ahead of him, and so do you as his parents. Many, many, many parents have felt this same way and experienced these same feelings. Some have lapsed into depression or let their fears immobilize them. Some have wasted countless hours on evaluation after evaluation searching for answers to the inexhaustible “WHY DID THIS HAPPEN TO US?” But many have risen to the occasion and used this information as fuel to propel them to explore.  They don’t just look to specialists to tell them what’s going wrong with their children, but to wholeheartedly pursue interventions that work to make their babies better. Sometimes it takes years, loads of money on therapy, and tons of parental blood, sweat, and tears to finally hear their little ones whisper “I love you.”

For many parents, it just takes making a firm decision to commit to using simple strategies day in and day out and an on-going belief that things will get better. Which kind of parent are you? I trust that since you are still reading this, you are one of the ones who will choose to make a difference.

As I say at the end of every piece of information I write for parents and at the ends of visits with parents who look like they are at the ends of their ropes, YOU CAN DO THIS! YOU CAN! YOU! You are your kid’s best hope. YOU! YOU CAN DO THIS!

——————————————————————————————————————–

I’ve written so much about helping toddlers with all kinds of developmental delays. If you’re looking around wondering which product is right for you, take a look at this list for some help!

If that’s too much information and you want one simple, go-to resource for parents, try here!

The post Communication Basics appeared first on teachmetotalk.com.

Then comes the second year.If the first year’s obsession is waiting for our baby to walk, then the second year’s obsession is waiting for our baby to talk. For some lucky mothers this happens early. A baby begins to coo around 8 weeks, babbles by 6 months, and then he starts to try to imitate common words before his first piece of birthday cake is served. For others it means waiting a little while longer, after the novelty of walking has worn off around 14 to 16 months.

Still others are waiting when that second birthday rolls around. Usually by then even the freakishly calm mother is wondering, Is something wrong? Should I be worried? We consult our families and friends. Invariably we hear any combination of the following, Calm down. It’s no big deal. Uncle Jim (or the neighbor’s son, or my personal favorite, Einstein) didn’t talk until he was 3. Strangely this well-meaning advice is not comforting for most of us worrying mother types because we suspect that something is wrong. More importantly, we don’t want to feel guilty later if we did nothing about it. Most of us also talk to the pediatrician, and sadly our concerns could even be dismissed by our most trusted and revered medical professional. You might be called overanxious. (By the way, in all of my education, I have never seen overanxious mother listed as an official reason babies don’t learn to talk on time.) When one mother took her non-verbal 3 year-old son in to be evaluated at a leading children’s hospital, the doctor advised, have another baby, and then he’ll talk.

Although many pediatricians are wonderful about listening to a parent’s concerns or identifying a potential developmental problem themselves during a visit, some doctors simply have not been trained to judiciously screen for communication delays, particularly before a child turns 2. Many urge parents to wait and see. For some children this could be an acceptable approach. In some cases maturity kicks in and a toddler simply outgrows an earlier issue that caused his parents great alarm. However, from my experience, a child hardly goes from being silent one day to speaking in full sentences the next, no matter what your great aunt so-and-so, the friendly lady at Wal-Mart, or even your pediatrician told you.

Language development simply does not happen overnight for most children. Even though you’ve probably been told not to compare your child to someone else’s or even your own older children, and no two children develop alike, there are patterns of communication skills that babies acquire within certain age ranges. If earlier skills are not mastered within a time frame, communication problems are more likely to develop.

Many pediatricians themselves become worried about their own children at an age when their colleagues might otherwise fail to issue a referral. As a busy pediatric speech-language pathologist specializing in early intervention, that is seeing children with language delays ages birth to three, I typically have several clients on my caseload who are children of physicians. Currently I am seeing four children with mothers who are pediatricians, one who is the daughter of a neurologist, and one whose father runs a family practice. All six of these children began the referral process to be evaluated in our state’s early intervention program before turning two, and four of them by 18 months.

Interestingly two of these mothers, pediatricians themselves, also began their initial conversations with me with a variation of this same question, Should I be worried? With all their medical training, they still weren’t sure enough about developmental communicative milestones to truly know if their own kids were at risk. This is shocking because most parents value their doctor’s knowledge above their own instincts. Often times, parents have expressed deep regret to me that they did not trust their own gut feelings earlier and insist that something be done, even against the advice of their pediatricians.

My advice to all parents has come to be, if you are worried that there’s a problem, there probably is. Occasionally there are parents, and even spouses, who have to be convinced that something is wrong, but more often than not, mothers suspect this long before other people begin to mention it. Even if you are initially pacified by everyone’s advice, but later feel that something really could be wrong, trust your instincts. Pursue additional information until you are satisfied that everything is moving along nicely in your child’s development, or until you find guidelines that confirm your suspicions that he or she is falling behind.

You can find charts that list developmental milestones in communication for babies and toddlers from many sources including parenting books, magazines, and websites. There is one listed on this site as well. Sometimes parents focus on what a baby is (or is not) saying rather than considering all of the other prerequisite skills that must occur before those first words are spoken. Talking is only a part of the communication process. A baby must understand words, have a desire to be with people, and be able to initiate and respond to interaction before words become meaningful. For example, a baby has to recognize who Mama is and want to call her to come get him out of the crib before his babbles of mama mama begin to truly express meaning.

The following guidelines can serve as red flags for parents who are wondering, Should I be worried?

1. Difficulty making and maintaining eye contact with an adult by 6 months

2. No big smiles or other warm, joyful expressions during interaction with another person by 6 months.

3. No back-and-forth sharing of sounds, smiles, or other facial expressions by 9 months.

4. No babbling by 12 months

5. No back-and-forth gestures, such as pointing, showing, reaching, or waving by 12 months

6. No consistent responding to their names by 12 months

7. No words by 16 months

8. No following simple and familiar directions by 18 months

9. No two-word meaningful phrases without imitating or repeating & says at least 50 words by 24 months

10. No back-and-forth conversational turn-taking by 30 months

11. Any loss of speech or babbling or social skills (like eye contact) at any age

The presence of any of these concerns warrants an immediate discussion with your pediatrician and insistence for a referral to an early intervention program and/or speech-language pathologist for a complete evaluation of your child’s communication skills.

Let me also add that babies who are doing well with social and language development exceed these milestones by leaps and bounds.These are very, very low thresholds for communicative skills. If your child is not meeting these basic guidelines, please don’t dismiss your feelings.There is in all likelihood a true developmental delay or disorder present.Seek professional help from your pediatrician, your local school system, or an early intervention agency.

If your child has accomplished these fundamental skills, but you’re still not sure that hes where he should be, please know that there are many, many things you can do at home to improve your child’s ability to talk.This entire web-site is dedicated to educating parents with successful techniques to improve your child’s communication skills. When you learn and implement these new strategies at home, you will make a huge difference in your child’s ability to communicate. Remember, involved and loving parents are a baby’s first and best teachers.You can do this, and this web-site is here to help.

The post When To Worry… Signs of Speech & Language Delays appeared first on teachmetotalk.com.